Antibiotic susceptibility of P. mirabilis isolated from clinical samples in Thi-Qar province

— Proteus spp . Is a motile dimorphic Gram negative bacteria belonging to the order Enterobacterales . P. mirabilis, the most commonly isolated species from clinical samples. The present study aimed to investigate the resistance of Proteus mirabilis isolates to different antibiotics. The study included the collection of 487 samples from different clinical sources, including urine, burns, wounds, ear swabs and diabetic ulcers. Different ages were involved of both sexes. Samples were collected from patients attending Al-Nasiriya and Al-Hussain Teaching Hospitals and private laboratories in Thi-Qar province, Iraq, from 29th of November 2021 to 20th of Abril 2022. A total of the isolates were diagnosed by different laboratory tests. The prevalence of P. mirabilis was 8.6 % among all collected samples. Female infection rate was 52.4%, male infection rate was 47.6 %. The age group ≥ 44 years was most commonly infected with P. mirabilis . In addition most P . mirabilis isolates were obtained from UTIs 45%. The antibiotic susceptibility test results showed a high resistance for Cefepime 83.3%, Ceftriaxone 78.8%, Tobramycin 73.3%, Ampicillin 71.4%, Amoxicillin/clavulanic Acid 69%, and Cefotaxime 60%. However, ciprofloxacin was the highest effective antibiotic 54.7%, followed by Meropenem 50%, and Gentamicin 45%. Finally, amikacin had intermediate activity 19%, followed by Netilmicin 16.6%.


Introduction
Hauser originally referred to a shape-shifting bacterium he had obtained from putrefied meat as proteus in bacterial nomenclature in 1885 (Hauser, 2013) 1 . Proteus mirabilis, the motile Gram-negative, dimorphic member of the Enterobacteriaceae family, has captivated scientists for many years due to its capacity to develop from short rods into long, multinucleate swarmer cells expressing thousands of flagella (Armbruster & Mobley, 2012) 2 . Members of the Proteus spp are common in the environment, including soil and water, where their presence is thought to be the result from fecal contamination. They are a normal component of the bacterial flora of both human and animal intestinal tracts. P. mirabilis is the most frequently isolated species from clinical samples, mostly from UTIs, but it can also be isolated from other infections such as the eye, ear, nose, skin, burn, meningoencephalitis, osteomyelitis, and wound infections (Girlich et al., 2020) 3 . A vast range of infections are caused by P. mirabilis, this species accounts for more than 3% of all nosocomial infections, and up to 44% of catheter-associated urinary tract infections, and its transmission is facilitated by an intrinsic translocation capacity utilizing peririchous flagella. Furthermore, P. mirabilis has a well-developed arsenal of exoenzymes such as urease, protease, and hemolysins, as well as a high biofilm-forming potential (Khayyat et al., 2021) 4 . Antibiotic resistance, or the ability of bacteria to withstand the effects of antibiotics for which they were once sensitive, poses a serious danger to the advancements made during the antibiotic era (Adedeji, 2016) 5 . like other Enterobacterales, Clinical strains of P. mirabilis have developed an increased resistance to antimicrobial drugs over the past few decades (Filipiak et al., 2020) 6 .

Collection of Samples
During the period from 29th of November 2021 to 20th of Abril 2022, a total of 487 samples were collected from different clinical sources, including 316 urine, 63 smears of burns, 20 wound swab, 69 ear swab, and 19 diabetic ulcer swab from both genders and different ages from hospitals and private clinics in Thi-Qar province, Iraq. The samples were transported on Carry Blair swabs and cultured on Blood agar and MacConkey agar, incubated aerobically at 37 °C for 24 hours. The isolated bacteria were identified according to microscopic, morphologic, biochemical, and API 20E tests.

Statistical Analysis
The statistical analysis proceeded in all groups of study, descriptive statistics analyzed by using Chi-square P. value ≤ 0.01 was considered to be All analyses were performed with statistical Package for the social sciences SPSS for Windows version 23.0 SPSS Inc., Chicago, 111. In the present study patients 'ages were between 3-81 years. The mean age was 43.2 years. The current results showed that the highest isolation rate was in the age group > 44 47.6% followed by the 30 -44 age group with 24.4%. While the lowest isolationn rate was 11.9% in the age group under 15 followed by the age group 15 -29 with the isolation rates 19.0 % and 19% respectively, as shown in  TABLE III. All of the 42 Proteus mirabilis isolates were examined for antibiotic susceptibility tests against 11 antibiotics. As shown in

IV. Discussion
The present study showed no significant differences in the infection rate between different clinical samples.  33 from Turkey found lower levels 35% and 26%.

ACKNOWLEGEMENT
We would express a special thanks and gratitude to the staff of laboratories of AL-Hussain Teaching hospital and the staff of other hospitals and private laboratories in AL-Nasiriya city for their great help.
evaluation of phenotyping and molecular resistance to antibiotics in Proteus species isolated from urinary tract infections in Ilam city.